401k Plan data: SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP plan

SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP 401k Plan overview

Plan Name	SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP
Plan identification number	001

SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

MEMORIAL HEALTHCARE IPA, GP has sponsored the creation of one or more 401k plans.

Company Name: MEMORIAL HEALTHCARE IPA, GP

Employer identification number (EIN): 954688463

NAIC Classification: 541600

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-01-01 CLINT EGENES
001 2014-01-01 CLINT EGENES 2015-08-10
001 2013-01-01 CLINT EGENES 2014-07-30
001 2012-01-01 AMY PARK
001 2011-01-01 STEVEN FICHTELBERG STEVEN FICHTELBERG 2012-10-08

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2015-01-01	CLINT EGENES
001	2014-01-01	CLINT EGENES	2015-08-10
001	2013-01-01	CLINT EGENES	2014-07-30
001	2012-01-01	AMY PARK
001	2011-01-01	STEVEN FICHTELBERG		STEVEN FICHTELBERG	2012-10-08

Plan Statistics for SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP

401k plan membership statisitcs for SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP

Measure Date Value
2015: SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP 2015 401k membership
Total participants, beginning-of-year 2015-01-01 71
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 0
Number of participants with account balances 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2012: SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP 2012 401k membership
Total participants, beginning-of-year 2012-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 52
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 30
Total of all active and inactive participants 2012-01-01 82
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 82
Number of participants with account balances 2012-01-01 82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP 2011 401k membership
Total participants, beginning-of-year 2011-01-01 148
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 14
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 86
Total of all active and inactive participants 2011-01-01 100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 100
Number of participants with account balances 2011-01-01 100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2015: SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP 2015 401k membership
Total participants, beginning-of-year	2015-01-01	71
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	0
Number of participants with account balances	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2012: SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP 2012 401k membership
Total participants, beginning-of-year	2012-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	52
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	30
Total of all active and inactive participants	2012-01-01	82
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	82
Number of participants with account balances	2012-01-01	82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP 2011 401k membership
Total participants, beginning-of-year	2011-01-01	148
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	14
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	86
Total of all active and inactive participants	2011-01-01	100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	100
Number of participants with account balances	2011-01-01	100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP

Measure	Date	Value
2015 : SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP 2015 401k financial data
Transfers to/from the plan	2015-06-01	$-2,708,992
Total income from all sources	2015-06-01	$92,386
Expenses. Total of all expenses incurred	2015-06-01	$94,342
Benefits paid (including direct rollovers)	2015-06-01	$94,179
Total plan assets at end of year	2015-06-01	$0
Total plan assets at beginning of year	2015-06-01	$2,710,948
Value of fidelity bond covering the plan	2015-06-01	$500,000
Other income received	2015-06-01	$92,386
Net income (gross income less expenses)	2015-06-01	$-1,956
Net plan assets at end of year (total assets less liabilities)	2015-06-01	$0
Net plan assets at beginning of year (total assets less liabilities)	2015-06-01	$2,710,948
Assets. Value of participant loans	2015-06-01	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-06-01	$163
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-06-01	$0
2012 : SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$309,936
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$849,734
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$849,199
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$17,203
Value of total assets at end of year	2012-12-31	$3,661,819
Value of total assets at beginning of year	2012-12-31	$4,201,617
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$535
Total interest from all sources	2012-12-31	$11,951
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$400,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	Yes
Amount of non-exempt transactions with any party-in-interest	2012-12-31	$63
Contributions received from participants	2012-12-31	$11,439
Participant contributions at end of year	2012-12-31	$36,297
Participant contributions at beginning of year	2012-12-31	$58,526
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$44,593
Administrative expenses (other) incurred	2012-12-31	$535
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$-539,798
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$3,661,819
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$4,201,617
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$3,050,851
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$3,288,759
Interest on participant loans	2012-12-31	$1,238
Interest earned on other investments	2012-12-31	$10,713
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$530,078
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$854,332
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$280,782
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$5,764
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$849,199
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	BAKER TILLY VIRCHOW KRAUSE, LLP
Accountancy firm EIN	2012-12-31	390859910
2011 : SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP 2011 401k financial data
Total income from all sources (including contributions)	2011-12-31	$516,665
Total of all expenses incurred	2011-12-31	$872,087
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$871,147
Value of total corrective distributions	2011-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$495,019
Value of total assets at end of year	2011-12-31	$4,201,617
Value of total assets at beginning of year	2011-12-31	$4,557,039
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$940
Total interest from all sources	2011-12-31	$21,948
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$400,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	Yes
Amount of non-exempt transactions with any party-in-interest	2011-12-31	$63
Contributions received from participants	2011-12-31	$339,666
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$13,580
Assets. Loans (other than to participants) at end of year	2011-12-31	$58,526
Assets. Loans (other than to participants) at beginning of year	2011-12-31	$112,099
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-355,422
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$4,201,617
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$4,557,039
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$3,288,759
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$3,427,752
Interest on participant loans	2011-12-31	$2,979
Interest earned on other investments	2011-12-31	$18,969
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$854,332
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$1,017,188
Net investment gain/loss from pooled separate accounts	2011-12-31	$-302
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$141,773
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$871,147
Contract administrator fees	2011-12-31	$940
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	KELLOGG & ANDELSON ACCOUNTANCY CORP
Accountancy firm EIN	2011-12-31	952793306

Form 5500 Responses for SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP

2015: SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	Yes
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2012: SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: SAFE-HARBOR 401(K) PROFIT-SHARING PLAN FOR EMPLOYEES OF MEMORIAL HEALTHCARE, IPA, GP 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

057717-K

Policy instance

Insurance contract or identification number	057717-K
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-06-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

057717-K

Policy instance

Insurance contract or identification number	057717-K
Number of Individuals Covered	82
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,010
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1088
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP PROGRAM
Insurance broker organization code?	3
Insurance broker name	JOHN COTTEE

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

057717K

Policy instance

Insurance contract or identification number	057717K
Number of Individuals Covered	100
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,230
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	MEMORIAL HEALTHCARE IPA, GP
Employer identification number (EIN):	954688463
NAIC Classification:	541600